Osteoarthritis, the progressively more painful form of arthritis that
afflicts the knee, hip, back, hand, and joints of millions of workers, will
become much more common over the next decade, posing major challenges for
employees and their employers.
That was the unanimous opinion of medical, disability, aging and work, and
human resources experts interviewed in August by BNA.
In 2010, some 27 million Americans had the so-far incurable degenerative
condition, roughly half under age 65, according to the National Institutes of
Health. NIH projects that in 2030, osteoarthritis will affect 60 million
Osteoarthritis is the most common form of arthritis. According to the
Arthritis Foundation, beyond a very small number of children, teens, and young
adults with the condition, it has historically begun to affect people when they
reach 45 to 55 years of age.
Osteoarthritis is certain to be a bigger workplace challenge in the next
decade for two reasons: the entire baby boom generation reaching their 50s, 60s,
and 70s, and the enormous increase in obesity over the last 35 years, Marcie
Pitt-Catsouphes, director of the Sloan Center on Work and Aging at Boston
College, told BNA.
Obesity is a major risk factor for osteoarthritis, noted Glenn Pransky,
director of Liberty Mutual's Center for Disability Research, part of the
workers' comp insurer's Research Institute for Safety. Every pound of additional
weight effectively puts four pounds of additional weight on peoples' knees and
hips, increasing the risk of osteoarthritis, Pransky said.
The adult obesity rate has rocketed up from 15 percent in 1975 to 36 percent
in 2010, according to the Centers for Disease Control and Prevention.
Meanwhile, by 2020, 37 percent of the labor force will be age 55 or older, up
from 25 percent in 2010, according to projections published in the January 2012
issue of the Bureau of Labor Statistics' Monthly Labor Review. One out of
every 10 workers will be 65 or older in 2020, up from one in 17 today, according
to the article by BLS economist Mitra Toossi.
With the combined factors of age and weight, the looming workplace impact is
hard to overstate, Pransky warned.
Employers can do a number of things to help reduce the incidence of
osteoarthritis and help affected employees remain productive.
Russell D. Robbins, senior clinical consultant for Mercer Health and
Benefits, suggested that good employer practices include:
that jobs and work tasks are designed ergonomically;
good fitness and weight management;
with arthritic employees to modify their jobs to accommodate their pain;
prescription benefit plans covering drugs that relieve the progressively
worsening pain of osteoarthritis; and
technologies that reduce or relieve employees of the need to use arthritic
Advances in pain medication have made a dramatic difference for many people
with osteoarthritis in terms of their ability to continue to work,
On technology, Robbins noted that speech recognition software can sharply
reduce the number of keystrokes and mouse clicks needed to create documents or
manage computer applications.
Scissor lifts that make it very easy to elevate objects from floor to waist
height are very helpful to employees working in store room, warehouse, and other
commercial and industrial jobs, Pransky said. He added that scissor lifts are
very cost effective, with prices beginning at well under $1,000.
Accommodation is usually very inexpensive compared to the costs of long-term
disability and medical costs, Pransky said.
To keep them connected to employment, employees suffering a period of
unusually high osteoarthritis pain should be offered a temporary, very
light-duty job rather than ordered to recover at home, Pransky suggested. Each
additional day a disabled worker is off work increases the risk that he or she
will not return to work, Pransky said. “There is a straight line between the
number of workdays lost and total medical costs,” he asserted.
Also effective, Pitt-Catsouphes said, are having one or more co-workers
handle ancillary job tasks that are difficult for an employee with advancing
arthritis, or moving an affected employee to a job that is easier for him or her
to perform. She also suggested part-time work and/or telecommuting.
When employees suffer work performance challenges related to osteoarthritis,
self-disclosure of their condition to management greatly simplifies initiating
employee-employer discussions that can lead to successful job accommodations,
observed Atlanta-based human resources consultant Carol Hacker.
Pransky said that in most cases, employees will self-report to their employer
when arthritis is interfering with their ability to do a job. The likelihood of
self-reporting is highest in workplaces in which employees are confident their
disclosure will not be used against them, Pransky added.
Wellness programs that lead people to improve their health and fitness and
maintain it will reduce the incidence of osteoarthritis and help people with the
condition feel better and stay productive much longer, according to NIH and the
But inducing most employees to adopt healthy behaviors is not easy.
Pitt-Catsouphes and Pransky each pointed to unusual workplace wellness
programs that they said have had good results.
Among other wellness practices, walking meetings, in which groups of
employees walk and talk together instead of meeting around a table, have been a
success at GlaxoSmithKline, Pitt-Catsouphes said.
Pransky suggested a two-prong approach that he said is working in Europe.
One prong: the employer replaces unhealthy food and beverages in cafeterias
and canteens with healthy--and subsidized--alternatives.
The other prong: the employer modifies elevator service in such a way that
employees must walk up and down stairs much of the time.
The two-prong system “has yet to take root in the United States,” Pransky
In such environments, managers can ask individual employees, “how's this job
working out for you?” and receive an open and honest reply, Pransky said. He
added that in a trusting work culture, employees with osteoarthritis can remain
productive for many years, even decades, provided they practice good
An employer might feel obligated to intercede with an employee who appears to
be in pain and struggling to accomplish what had been a regular work task.
However, employers seeking to help such an employee need to proceed with care
to avoid possible liability under the Americans With Disabilities Act, noted
Washington, D.C.-based attorney Kenneth M. Willner, a partner in the employment
law section of Paul, Hastings, Janofsky & Walker LLP.
A manager who suggested to an employee that arthritis was slowing his or her
typing down, prior to the employee disclosing it, would open the door to an ADA
lawsuit charging that the employer regarded the employee as having a disability,
Instead, the manager should approach the employee without mentioning any
potential cause of his or her difficulty, Willner said. He suggested that the
manager ask, “Are you having trouble with the keyboard?”
Hopefully that will lead to the employee self-reporting and the start of
interactive discussions. If it does not, the manager could say, “We don't want
to pry. You might want to contact the employee assistance program,” or suggest
that the employee contact the company's ergonomics consultant, Willner said.
Such steps will hopefully lead to the employee disclosing his or her
osteoarthritis to the manager, beginning the interactive process.
In health care settings, where patient wellbeing is at risk, Willner said
stronger action can be taken. For example, the employer can suspend the surgery
privileges of a surgeon who cannot hold a scalpel steady, and require the
surgeon to undergo a medical evaluation. Nonetheless, declaring the possible
medical cause of the shaking hand before the medical evaluation could expose the
employer to an ADA claim, he said.
When an employee with a disability and an employer begin discussing possible
accommodations, the employer needs to avoid saying that the condition makes it
impossible for the employee to do a broad class of jobs, Willner said. However,
he said employers may determine that an employee's disability makes it
impossible for him or her to do one job, without violating the ADA.
Employer-sponsored health assessments can be effective in helping employees
adopt healthy behaviors that can help prevent osteoarthritis and help manage the
condition when it is present, said Pitt-Catsouphes. She said the assessments are
broadly effective when done in settings that provide strong follow-up. Hospitals
have had notable success in using health assessments to trigger real change in
employees' eating and exercise choices, she said.
Willner said health assessments can be ADA compliant--if they are completely
voluntary for employees and if doctors disclose nothing about employees' health
status to the employer.
Employers may instruct medical personnel to refer employees with
osteoarthritis to an EAP, Willner said. Hopefully, he said, the employee will
subsequently self-report to the employer, beginning the interactive process that
can lead to an accommodation
By Jeff Day
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